Celebrating the First APA Panel of Transgender Psychiatrists of Color: A Conversation With Emrys Fonseca, MD, MS

CLINICAL CONVERSATIONS

At this year’s American Psychiatric Association Annual Meeting, they held the first ever panel of transgender psychiatrists and students of color. In celebration of this event, and in honor of Pride Month, Psychiatric Times sat down with Emrys Fonseca, MD, MS, to hear more.

Psychiatric Times: You were part of a historic, groundbreaking panel at this year’s APA Annual Meeting: the first panel of transgender psychiatrists and students of color. How did that come about? What was it like to be part of that endeavor?
Emrys Fonseca MD, MS: It was incredibly exciting to develop this historic landmark for the APA! Since 2022, I have been presenting at multiple national conferences (including APA) on transgender health and experiences of transgender trainees and clinicians. The idea for this presentation evolved over time. At the 2023 APA annual meeting, we celebrated the 50th anniversary of John E. Fryer, MD's speech at the 1972 APA annual meeting. This panel included the screening of the documentary Cured. During Dr Fryer's speech, he talked (anonymously, at the time—literally wearing a mask) about being gay and a psychiatrist. As I sat on that panel, being an openly transgender psychiatrist of color, I echoed Dr Fryer's words, telling the room, "I am transgender, I am a psychiatrist." In his speech, Dr Fryer said, "As psychiatrists who are homosexual, we must look carefully at the power which lies in our hands to define the health of others around us." Being able to exist in this professional space is a privilege for all of us—but the weight is especially felt by folks like me who occupy an intersection of identities that are not the norm (yet). Some of that weight is a sense of responsibility to advocate for change, through existence, through education, through connection.

Dr Fryer's speech was not perfect. There were portions of it containing deeply stigmatizing language. Our heroes are not flawless. None of us are. As we move towards depathologizing queerness and transness—issues that do not exist in a vacuum—it is more and more clear that all systems of discrimination and oppression are connected. We cannot move forward without an intersectional approach. So while I was part of what (I believe) was the APA's first all trans presentation in 2022, I felt a moral obligation to join voices specifically with my trans siblings of color in psychiatry—attendings, trainees, and medical students. Our panelists were Serena Amegadzie, MD (she/her, Black trans woman, first-generation American of Ghanaian and Jamaican descent), Kevo Rivera, MD (all pronouns, genderfluid, second-generation Filipinx-American, whose parents were once undocumented), a medical student who would like to stay anonymous (any pronouns, trans man, first-generation Chinese-American originally from Hong Kong), and myself (they/he, nonbinary, nonimmigrant alien of Goan Indian descent). Being a part of this endeavor was a gift—one that we were so happy to share with those who attended.

PT: What important insights came out of this discussion?
Fonseca: The most joyful insight was that we have so many colleagues who care, who want to learn more—about themselves, about their colleagues, about their patients, who want to do better, who are engaged, who show up vulnerably and authentically, who lift each other up. Our panel was a celebration of each person's individuality. When we are able to witness and embrace every part of ourselves, we can more fully witness and support each other and our patients. We drew on literature but also shared our professional and personal journeys, as well as our clinical experiences.

We talked about the experience of our identities and how it impacts different aspects of our professional life—in the clinical setting as well as in terms of navigating the workplace. We talked about the meaningfulness and importance of working with our community, blending testimonial, education, and advocacy. Our presentation highlighted how our intersecting identities impact the way we (ALL of us) show up in multiple settings, including clinical and educational settings. We engaged the audience in meaningful and thoughtful reflection about their own experiences. Our attendees participated in a lively discussion and left our presentation with a greater sense of understanding and community. Gender affects us all, race and ethnicity affect us all, and we are all connected. 

PT: How does identity impact clinical practice?
Fonseca: Oh, this is a HUGE question! And not just applicable to LGBTQ+ clinicians either. Everyone's identity impacts their clinical practice in one way or another, which is why it is so important to keep engaging in introspective examination of one's cognitive and affective frameworks and narratives. We bring our whole self into the room, consciously or unconsciously, and if we do not know what we are bringing in, we cannot be intentional about what we do and do not choose to wield in the room.

What I am saying is that it is essential for us to be aware of our biases so that we do not inadvertently hurt our patients. And it is essential for us to be aware of our strengths and fully own them, so we can empower our patients too. For me, working in gender affirming care, that can be something as simple as existing in my role and encouraging some of my younger patients to pursue careers in medicine if that is what they so choose to do, or reassuring some of my older patients that there is nothing shameful about pursuing medical transition—if that is something that they've been yearning to do for themselves—and that, in a supportive and safe environment, this can be a personal victory.

PT: It’s Pride Month. What’s one thing you wish your psychiatrist and mental health clinician peers knew about treating LGBTQ+ patients? How should clinicians be engaging with patients around discussions of identity?
Fonseca: Respectfully and thoughtfully. Any discussions of identity need to serve the patient's best interests, not just satisfy the clinician's curiosity. It is also important that clinicians working with individuals from any community are, in some way, immersed within its culture.

So, for the LGBTQ+ community, this does not mean that we expect everyone to show up to work in rainbow colors covered in glitter. It simply means that the only intersection you have with a population you work with should not be confined to the clinical space. What I am saying is that we humans are skilled at recognizing patterns. If the only people you encounter from a certain community are your patients, over time, you will start to develop generalizations, assumptions that everyone from that community fits whatever clinical phenotypes you have encountered. Instead, what we want is for folks to broaden their worlds, make friends with people who are different—genuine, caring friendships, not just for the sake of "diversity." And you might learn a few new things about yourself along the way, whether it is a new genre of music you enjoy or a new way to reframe an old thought pattern. This applies to most populations, not just the LGBTQ+ community.

PT: In your opinion, what makes a great ally?
Fonseca: A great ally is someone who shows up as a fellow human and who is willing to use what privileges they have to the best of their ability to protect spaces for minoritized individuals to join the conversation, to advocate for representation in spaces where minoritized individuals do not have a voice, and to keep learning and growing and humble. Again, nobody is perfect, so I would say that the most important thing about a great ally is that they are gentle with themselves too through the process, and hold fast to their persistence. Sustainable change takes intentionality, care, and patience. Great allies also show up for other allies. We all need allies. We all need each other.

PT: Is there anything else you’d like to share?
Fonseca: We recently celebrated 50 years of homosexuality being removed from the DSM- at the time, the DSM-II. However, this 1974 removal was not absolute. It was replaced with "Sexual Orientation Disturbance" in DSM-II Revision and then with DSM-III renamed to "Ego-Dystonic Homosexuality" in 1980, and finally entirely removed in 1987 with DSM-III-R. So, it is not truly 50 years yet. It is not even 40.

Society is still continuing to work towards fully integrating this depathologization. But one thing we have learned along the way is that our profession had (and continues to have) the potential to create impactful, meaningful, and long-lasting sociocultural change—even outside of the realms of mental illness. I think that if he were alive today, Dr Fryer would agree that it is important for psychiatry to work towards the depathologization of transgender people in the same way that homosexuality was depathologized. We have moved from a pathologization of identity to a focus on dysphoria, and in time, it would be wonderful to see this evolve so that the focus is on gender embodiment rather than a corrective intervention. I would love to see everyone celebrate themselves and those around them, and approach differences with warm curiosity and kindness.

I also wanted to put in a plug for the American Association of LGBTQ+ Psychiatrists (AGLP). They have been an exceptional resource and support for me, and have also been behind a lot of the historic changes that I mentioned earlier in our discussion. AGLP welcomes not just members of the community but also allies, so please reach out. We are here, we are queer, we have been here, we're not going anywhere, and we'd love to get to know you!

Dr Fonseca is a senior associate consultant in Psychiatry/Mayo Clinic Scholar at the Mayo Clinic in Rochester, MN, and works at the Transgender and Intersex Specialty Care Clinic.